Thursday, October 13, 2011

HHS to Investigate 'Incident To' Billing in 2012

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) next year will conduct an investigation into how many office visits, consultations, and other services are performed by unqualified nonphysicians under Medicare's "incident-to" billing rules, says a MedscapeMedical News article.

Physicians have drawn much of their Medicare reimbursement through incident-to billing. An OIG study in 2009 revealed that when Medicare allowed physicians to bill the program for more than 24 hours of service within a single day, nonphysicians had performed half the services.

OIG finds no fault in that pattern, says Medscape. OIG's concern is that 21% of the services were performed by nonphysicians who lacked needed licenses or certifications, verifiable credentials, or the appropriate training, to render the services. (Read APTA's press release on OIG's 2009 report.)

In its 2012 work plan, OIG says that incident-to billing "may be vulnerable to overutilization and expose Medicare beneficiaries to care that does not meet professional standards of quality." OIG intends to determine whether incident-to claims have a higher error rate than ordinary ones and assess the ability of the Centers for Medicare and Medicaid Services to monitor incident-to services, which are not identified as such on claims.

This is just 1 new investigation that the HHS plans to conduct next year. OIG also will look into such diverse issues as the extent to which physicians are opting out of Medicare, the safety and quality of care at ambulatory surgery centers, and physician-owned companies that distribute spinal implants, the article says.